| NPI | 1053606160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ND RPH5625) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 118940) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2023-08-18 |